CARE HOME ADULTS 18-65
Muston Road (70) 70 Muston Road Filey North Yorkshire YO14 0AL Lead Inspector
Pauline O`Rourke Unannounced Inspection 8th August 2007 09:30 Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Muston Road (70) Address 70 Muston Road Filey North Yorkshire YO14 0AL 01751 474740 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) mustonroad@wilfward.org.uk www.wilfward.org.uk The Wilf Ward Family Trust Mr Michael Clements Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Registered for 4 residents with a Learning Disability some of whom may also have Physical Disability Date of last inspection 24th August 2006. Brief Description of the Service: Muston Road is registered to provide long-term accommodation to 4 younger adults who have a learning disability and/or a physical disability. Mr Michael Clements is the Registered Manager. The property is owned by the local health authority with care provided by the Wilf Ward Family Trust a registered charity. Muston Road is a large detached property situated on a main road into Filey. It is within walking distance of the town centre. A former hotel on two floors, it provides accommodation for four residents. There are three large bedrooms without en-suite facilities and a separate flat with its own facilities. A large private and secluded garden is situated to the rear of the premises. There is no passenger lift. Information about the service is available on request and it can be provided in a variety of formats. On the 8th August 2007 the cost of a placement was £1522.20 and the people who live there pay a contribution towards this cost between £108.95 and £143.60 per week, this is determined through a financial assessment. This covers the accommodation costs, the local health authority and social services departments meet the cost of the personal care. They and their carer are informed of this cost prior to their admission. Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key inspection has used information from different sources to provide evidence for this report. These sources include: • • • • Reviewing information that has been received about the home since the last inspection. Information provided by the registered person on a Annual Quality Assurance Assessment form Comment cards returned from all 3 people living at Muston Road, one relative and one healthcare professional. A visit to the home carried out by one inspector that lasted for three and a half hours. During the visit to the home three people who live at the home and three staff were spoken with. Care records relating to three people, two staff members and the management activities of the home were inspected. Care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at Muston Road for the people living there. The deputy manager was available to assist throughout the visit and for feedback at the close. What the service does well:
All the people who use, or want to use the service at Muston Road have to tell someone of the help they need. This information is used to make a care plan. The care plans used are detailed and tell the carers everything from how people like to get up, go to bed, what they like to do during the day and how it is best to communicate with them. These care plans are reviewed regularly. Those people who live at Muston Road have a full programme of activities and they enjoy going out shopping, holidays, trips to the seaside, and local pubs. There are enough staff on duty to help the people who use the service to get out and about as an individual. Everyone who lives at Muston Road has a key worker. This member of staff keeps in touch with the family and makes sure that birthdays and Christmas cards are sent to the family. They also make sure that the person they help has enough clothes and personal items. They also make sure that everything goes along according to the person’s diary. Feedback from one person said ‘The staff support me and allow me to make decisions. I can do what I want during the day with support from staff’ and ‘Muston road is my home and staff make sure I am comfortable safe, warm and that I can access activities’ other people said ‘I like living here and feel well cared for, staff treat me well and they respect my privacy. I am involved in making decisions, there are good activities, the food is nice and I feel safe’
Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 6 The staff are well trained and have been thoroughly checked before they started working for the Wilf Ward Family Trust at Muston Road. The staff have regular training to make sure they have the skills needed to ensure the needs of the people who live there are met. The service is well managed and the staff said that the manager listens to them and asks for their opinion. The manager makes sure that any work needed on the building is carried out and she makes sure it is a safe place to live and work. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who decide to use this service have the information needed to ensure their needs can be met. EVIDENCE: There have been no recent admissions to the home, but a discussion was held with the staff how new admissions would take place. The Wilf Ward Family Trust has a proven admissions policy and this ensures that a multi disciplinary assessment is undertaken prior to any admission. The home usually receives an assessment and makes as initial decision about suitability before the person who requires support and their family are contacted. The process then becomes a series of visits and short stays to determine whether the placement is suitable. A trial period is then planned and the length of this trial is dependent on the needs of the individual. As part of the assessment process the wishes of the established residents are taken in to account. The case files seen of people living at Muston Road contained comprehensive assessments and evidence of regular reviews of the care plans. Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are able to make decisions on a day-to-day basis about their lives and this allows them to remain as independent as possible. EVIDENCE: All the people in the home have a comprehensive care plan and there is evidence to show these are reviewed when necessary. Other health professionals indicated that the staff are good at requesting reviews of specialist services and asking for help when the persons needs change. The staff were knowledgeable about the care plans and they involve the person and their relatives, where appropriate, in all reviews. The plans included information about the language and behaviours used by the people in the home to communicate. Staff were observed communicating effectively with all the people in the home and this allows people to make their own choice and decisions about their day-to-day activities.
Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 10 Everyone had up to date risk assessments in place in relation to their individual needs and their differing daily living abilities. These documents are reviewed regularly incorporating specialist assistance when necessary. The staff accommodate the variety of needs very well. Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to make decisions about their daily life and staff provide appropriate support and encouragement for them to remain independent. EVIDENCE: The case files for each person included a list of activities they like to do. A diary of planned activities for individuals is also provided. Each person has a holiday and outings photo file that documents what they have been doing. These activities included social and where possible educational tasks. One person likes to bake and make their own hot drinks and staff are invited to join them. During the visit each person went in to the local community accompanied by a member of staff. Each person is encouraged to go for a walk every day unless they have other activities planned. Throughout the day the people that were at home choose where they wanted to be and if they
Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 12 wanted company, one person spent time in their room watching TV, whilst another helped staff fold up laundry from the washing line and then took their knitting in to the summerhouse. Feedback received from one person said ‘The staff support me and allow me to make decisions. I can do what I want during the day with support from staff’ others used the pictorial survey and indicated ‘I like living here and feel well cared for, staff treat me well and they respect my privacy. I am involved in making decisions, there are good activities’ There is a visitor’s policy in place and this is included in the information available to people and their families. Each of the service files had important family contacts and where appropriate family contact is maintained with support of the staff. One relative responded to the surveys ‘I am generally satisfied with…. care and the helpful attitude of staff’ During the site visit it was clear that people could choose their own daily routines and their preferences were identified in their care plans. Whilst not everyone communicated through speech his or her communication with the staff was clear. They have a varied diet and where necessary advice has been sought from the dietician to ensure that their needs are met. Specialist equipment was supplied and at all times people were encouraged to be independent. The menus are planned around the likes and dislikes of the people in the home. The mealtime observed was relaxed and staff offered appropriate encouragement and support. Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s health and personal care needs are met on an individual basis. The staff employ the principles of respect, dignity and privacy in all interactions with them. EVIDENCE: The care plans seen were pertinent to the individual concerned. The included specific response for staff to behaviours demonstrated by the person they were assisting with their personal care. For one person this included a relaxation plan to help with their behavioural problems. Each person also has behavioural guidelines for personal care activities such as meal times, bathing and being outside. Staff were observed interacting with people in positive manner that was respectful and ensured their privacy was maintained. Evidence was available that staff on a regular basis reviews the care plans. Staff were knowledgeable about the variety of interventions used and with which individual they were appropriate for. Daily records are kept for each person and some of these were composite records. In discussion with the deputy manager he agreed to dispense with these records and just use the
Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 14 individual diaries for recording. A letter of confirmation from the manager that this has been implemented was received by this office on 10th August 2007. People in the home can access their own GP when necessary. There was also evidence in their case files to show that they access specialist health services when appropriate. These include the dentist, dietician, well woman and man clinics. Feedback from a health care professional stated ‘The care service always seeks advice and acts upon it to manage and improve individuals health care needs. Health care needs met by the service and individuals are treated with respect and dignity’ The medication is stored in an individual locked cupboard. Medication is dispensed directly from a monitored dosage system and the records kept were accurate and up-to-date. There is a stock control record and two members of staff sign all medication records. All staff have completed a learning distance course in The Safe Handling of Medicines, they also cover the topic on the LDAF Nation Vocational Qualification level 2 training. The Wilf Ward Family Trust has also provided supplement training for the staff to ensure they continue to manage the medication appropriately. Staff encourage people to take their medication and are aware that they are allowed to refuse it. Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home and their representatives are able to express their concerns through the complaints procedure and are protected from abuse, so their rights are protected. EVIDENCE: There is a robust complaints procedure in place, a copy of which is available in the residents file. They are in large print and picture format. The Wilf Ward Family Trust also has a resident Group, which meets to discuss how residents might like to improve the services available. A representative is named and contact details are displayed in the hallway of the home. The Wilf Ward Family Trust or the Commission has received no complaints. Feedback from a person in the home said ‘I can talk to any member of staff or Mike the manager if I am unhappy. I complain to Mike if I need to’. An Adult Protection protocol is in place and staff were aware of their responsibilities under this procedure. Staff have received training through Nation Vocational Qualification and their induction and foundation training. The manager also reinforces the training in the monthly staff meetings. Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people in the home live in a well-maintained, clean property that allows them to access all areas, promoting their independence. EVIDENCE: The home is a three bed roomed house with an integral flat. The bedrooms are large and have been personalised by the occupant. The flat has its own bathroom, small kitchen, lounge and bedroom. It is accessible to all the people who live in the home at this time although if the mobility of anyone of the occupants decreases there is the option of making a ground floor room currently used by staff in to a large bedroom. There is a large well-maintained garden to the rear of the property with a summerhouse. Feedback from one person said ‘We have a lovely garden and summerhouse. I spend lots of time in the summerhouse when it is sunny I find it relaxing’. Throughout the visit people were seen accessing all areas of the home with and without support from the staff.
Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 17 The home was clean and odour free. The laundry is suitable for the needs of the people who live there and staff were knowledgeable about the infection control policy. Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are supported by well-trained staff in sufficient numbers that they are seen as individuals and the care provided is pertinent to their needs. EVIDENCE: The Wilf Ward Family Trust has a well established and robust recruitment process and all necessary checks would be carried out prior to anyone being deployed in the home. Staff records for two members of staff were seen and these contained all the documentation required by the recruitment policy. The rota’s received prior to the inspection indicated that the home is staffed appropriately. During the site visit people’s plans provided the staff with clear instruction. Every person in the house requires one-to-one supervision in side and two to one supervision outside the home. The staff spoken with said that they felt the staffing was adequate and that they had time to spend with the residents on a one-to-one basis. The whole routine during the visit was relaxed and staff were seen interacting positively with the residents
Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 19 Staff have access to statutory training on a regular basis and the records seen showed that this training was up to date. Staff also received training in Conflict Management as the people who live at Muston Road have complex challenging behaviour needs. Other training completed includes a medication course, and National Vocational Qualifications level 2 and level 3 in care. Staff have individual supervisions and this gives them an opportunity to discuss with the manager their training needs. Staff said that they had access to training on a regular basis through the Wilf Ward Family Trust and if necessary external trainers were supplied where they required specific training in relation to a care plan. Throughout the visit the interactions seen between staff and the people who live in the home were relaxed, friendly and in line with their care plans. Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed home where the administration of the home is based on openness and respect. This allows the residents to retain their individuality and independence. EVIDENCE: The registered manager had considerable experience in the provision of care for service users who had complex needs. He was fully qualified having obtained a National Vocational Qualification at level 4 and the Registered Manager’s Award. Staff said that he operates an open door policy and those spoken with said they would be happy to take any concerns to him. He also operates as part of a team and works with the people in the home as well as maintaining the administration records up to date.
Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 21 The Wilf Ward Family Trust has a thorough quality assurance programme within the trust and where possible involves the people who receive services as much as possible. Within the home the quality assurance is complemented by the monthly visits from the managers line manager, staff meetings, and the monthly reviews of people’s care plans. All the working practices within the home are safe and staff keep accurate accident records, this information is used to inform the care plan and in requesting specialist input either through training or actual support. Staff have received training in the health and safety procedures and all the policies are read by the staff. The records relating to health and safety issues that were seen during the visit were up to date Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 X 34 4 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 X 4 X X 4 X Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Muston Road (70) DS0000007840.V343632.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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